Estimating PMTCT's Impact on Heterosexual HIV Transmission: A Mathematical Modeling Analysis
Year: 2015
Type: article
Abstract: INTRODUCTION: Prevention of mother-to-child HIV transmission (PMTCT) strategies include combined short-course antiretrovirals during pregnancy (Option A), triple-drug antiretroviral treament (ART) during pregnancy and breastfeeding (Option B), or lifelong ART (Option B+). The WHO also recommends ART for HIV treatment and prevention of sexual transmission of HIV. The impact of PMTCT strategies on prevention of sexual HIV transmission of HIV is not known. We estimated the population-level impact of PMTCT interventions on heterosexual HIV transmission in southwestern Uganda and KwaZulu-Natal, South Africa, two regions with different HIV prevalence and fertility rates. MATERIALS AND METHODS: We constructed and validated dynamic, stochastic, network-based HIV transmission models for each region. PMTCT Options A, B, and B+ were simulated over ten years under three scenarios: 1) current ART and PMTCT coverage, 2) current ART and high PMTCT coverage, and 3) high ART and PMTCT coverage. We compared adult HIV incidence after ten years of each intervention to Option A (and current ART) at current coverage. RESULTS: At current coverage, Options B and B+ reduced heterosexual HIV incidence by about 5% and 15%, respectively, in both countries. With current ART and high PMTCT coverage, Option B+ reduced HIV incidence by 35% in Uganda and 19% in South Africa, while Option B had smaller, but meaningful, reductions. The greatest reductions in HIV incidence were achieved with high ART and PMTCT coverage. In this scenario, all PMTCT strategies yielded similar results. DISCUSSION: Implementation of Options B/B+ reduces adult HIV incidence, with greater effect (relative to Option A at current levels) in Uganda than South Africa. These results are likely driven by Uganda's higher fertility rates.
Source: PLoS ONE
Language: English
Subfield: Infectious Diseases
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,382
Funders: University of Washington, Achievement Rewards for College Scientists Foundation, National Institutes of Health, National Institute on Drug Abuse, National Institute of Allergy and Infectious Diseases, Fogarty International Center, National Center for Advancing Translational Sciences, Eunice Kennedy Shriver National Institute of Child Health and Human Development
Awards: Pediatric HIV-1 in Africa: Pathogenesis and Management, Population Research Training, UCLA Clinical and Translational Science Institute, Interventions to decrease HIV infectiousness in Uganda, Prevention Umbrella for MSM in the Americas, G3623588523, TransmissionBehavior in Partnerships of Newly HIV Infected Southern Californians, Interdisciplinary Research Training in Reproduction for Indian Fellows, Statistical Methods for Network Epidemiology, Migration to Urban Slums, Sexual Networks, and HIV in Ghana, G6625095162, Southern California Primary Infection Program, Center for Studies in Demography and Ecology, Institute of Translational Health Sciences, G7791962275, G7810591162, G9000186388, G9000301557, University of Washington/Fred Hutch Center for AIDS Research, Demography Center, Institute of Translational Health Sciences, Social Network Dynamics, HIV, and Risk Reduction Among Younger Black MSM
OpenAlex ID: W1917041206